Wiki Respiratory Failure with hypoxemia

[hbarney1]

So I keep getting denials from Inpatient claims where they say that the diagnosis code is J96.01-Resp Failure with hypoxia, but when I look in the discharge summary I only see hypoxemia.

So since hypoxia (deficiency in the amount of oxygen reaching to the tissue) and hypoxemia (abnormal low concentration of oxygen in blood) are 2 totally separate meanings does that mean that I can't use J96.001; but instead I need to use J96.00 since they are not stating hypoxia or hypercapnia?

 

[Tiffany M Eason]

Acute Hypoxemic Respiratory Failure

J9601 is the correct code. When coding from the 3M encoder, under hypoxemia you have the option to select respiratory failure and the code that you get is J9601. I hope this helps.

 

[hbarney1]

Right now I do not have access to 3M so is there something that will help me out? Is there a website or any guidelines that you can provide that'll help me understand because right now it still isn't making sense.

 

[Tiffany M Eason]

Acute Hypoxemic Respiratory Failure

Does the patient have Respiratory failure? Hypoxemic(R09.02) alone is a symptom and sign code. Chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory findings states that chapter 18 is your go-to chapter for codes when the documentation doesn't include a definitive diagnosis, but documentation does include the signs or symptoms that triggered the visit. So if the patient does have respiratory failure and hypoxemia that's a combination code.